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Multicenter Study
. 2024 Dec 1;35(8):633-640.
doi: 10.1097/MCA.0000000000001385. Epub 2024 May 15.

Prevalence and location of coronary artery disease in anomalous aortic origin of coronary arteries

Sandra Zendjebil  1 , Athanasios Koutsoukis  2 , Thomas Rodier  3 , Fabien Hyafil  4 , Xavier Halna du Fretay  1   5 , Patrick Dupouy  2 , Jean-Michel Juliard  1 , Reza Farnoud  1 , Phalla Ou  6 , Jean-Pierre Laissy  7 , Camille Couffignal  3   8 , Pierre Aubry  1   9 ; ANOCOR investigators
Collaborators, Affiliations
Multicenter Study

Prevalence and location of coronary artery disease in anomalous aortic origin of coronary arteries

Sandra Zendjebil et al. Coron Artery Dis. .

Abstract

Background: The prevalence and location of coronary artery disease (CAD) in anomalous aortic origin of a coronary artery (AAOCA) remain poorly documented in adults. We sought to assess the presence of CAD in proximal (or ectopic) and distal (or nonectopic) segments of AAOCA. We hypothesized that the representation of CAD may differ among the different courses of AAOCA.

Methods: The presence of CAD was analyzed on coronary angiography and/or coronary computed tomography angiography in 390 patients (median age 64 years; 73% male) with AAOCA included in the anomalous coronary arteries multicentric registry.

Results: AAOCA mainly involved circumflex artery (54.4%) and right coronary artery (RCA) (31.3%). All circumflex arteries had a retroaortic course; RCA mostly an interarterial course (98.4%). No CAD was found in the proximal segment of interarterial AAOCA, whereas 43.8% of retroaortic AAOCA, 28% of prepulmonic AAOCA and 20.8% subpulmonic AAOCA had CAD in their proximal segments ( P < 0.001). CAD was more prevalent in proximal than in distal segments of retroaortic AAOCA (OR: 3.1, 95% CI: 1.8-5.4, P < 0.001). On multivariate analysis, a retroaortic course was associated with an increased prevalence of CAD in the proximal segment (adjusted OR 3.4, 95% CI: 1.3-10.7, P = 0.022).

Conclusion: Increased prevalence of CAD was found in the proximal segment of retroaortic AAOCA compared to the proximal segments of other AAOCA, whereas no CAD was observed in the proximal segment of interarterial AAOCA. The mechanisms underlying these differences are not yet clearly identified.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Type of ectopic course according to AAOCA arteries (n = 390). AAOCA, anomalous aortic origin of a coronary artery; Cx, circumflex; LAD, left anterior descending; LM, left main; RCA, right coronary artery.
Fig. 2
Fig. 2
CAD prevalence in the proximal and distal segments according to the type of AAOCA course. AAOCA, anomalous aortic origin of a coronary artery; CAD, coronary artery disease.
Fig. 3
Fig. 3
Illustration of CAD prevalence (%) in the proximal segment according to the type of AAOCA course. Panel A: CT image of a left main with a prepulmonic course; panel B: CT image of a left main with a subpulmonic course; panel C: CT image of a right coronary artery with an interarterial course; panel D: angiographic view of a circumflex artery with a retroaortic course. Dotted lines indicate the border between the proximal and distal segments. AAOCA, anomalous aortic origin of a coronary artery; CAD, coronary artery disease; CT, computed tomography; IVUS, intravascular ultrasound.
Fig. 4
Fig. 4
Illustration of CAD presence in different AAOCA. Panel A: CT image of a circumflex artery (black arrow) arising from the right sinus and associated with a retroaortic course. Presence of a calcified plaque (white arrow) on the ectopic segment. Panel B: CT image of a right coronary artery (black arrow) arising from the left sinus and associated with an interarterial course. Presence of a calcified plaque (white arrow) on the nonectopic segment. To note, the ectopic segment is free from CAD. AAOCA, anomalous aortic origin of a coronary artery, CAD, coronary artery disease; CT, computed tomography.
See this image and copyright information in PMC

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